April to June 2018

A summer break to look forward to in May. April was very pleasant, lots of intermittent showers which kept things cool.

A few days which were really hot. As expected a few heat exhaustion patients, some diarrheal diseases, few viral fevers. 

Patients continue to meet us daily

June started on a subdued not, with workshops at Rishi Valley School on teaching learning, counseling. The need for counseling services seems to be a felt need.

Projects wise

cVEDA - is up and running. Have made measured progress in ticking off the required numbers. The staff also trained now and are able to keep up with the questionnaires.

Having Amritha Gourisankar overseeing the project, is a huge help. She has really taken charge of the project.

Numbers: 

TOTAL: 3631

Males: < 15: 102; 16 - 65: 1117; > 65: 333

Females: < 15: 68; 16 - 64: 1661; > 65: 350

Income Levels: < 48000 pa: 3504, > 48000: 127

70 yr old with a mass lesion. We decided against investigating any further and just treated him symptomatically

40 M, with an Acute Direct Inguinal Hernia

45 M walk in patient - BP recorded on visit
With 2 drugs he is well conrtrolled

Wound debridement of a Diabetic Ulcer
being done by our nurse

Jan to March 2018

Winter stayed on for quite a while, a blessed relief.
A conscious decision was made to try and reduce the numbers of patients accessing the RHC daily. We found that well off patients and patients from far towns and cities were thronging the RHC for treatment of Diabetes as well as Thyroid disorders. The loads were becoming too much to handle. We started sending back patients as well as giving appointments.
However the aged, those with complications were given priority to be seen that day itself.

Most afternoons, I find it increasingly difficult to focus on what the patients are saying, registering their ailments and then try and find appropriate remedies for them. There, would,  possibly be some, not so appropriate treatment as a consequence of fatigue. However what we ensure is that the basic medications are correct. For example dose adjustment for diabetics, diet advise, foot care are not compromised upon. Aches and pains, dyspepsia are possibly given short shrift!

6706 patients accessed the RHC during this period
Children (less than 15) M 242 : F 264
Elderly ( more than 65) M 747 : F 709
Adults: M 2190 : F 2554

Income - less than 48000 pa : 6563 and more than 48000 143

Treatment of Diabetic Foot

Diabetic feet are quite common amongst our patients. Its a leading cause of debility, morbidity resulting in loss of wages, increasing difficulty in finding work etc and a source of stress for the family to look after one with a diabetic foot, particularly those which are infected and smelling like god knows what. 

To be able to treat and provide some sort of quality of life is of paramount importance.

The pictures below show an old lady with a diabetic foot who has been provided with orthotic footwear designed at the RHC. An excellent cobbler who understands what is needed and is able to translate and execute the design that I give him helps us make this footwear.

What was touching was the husband, himself with creaky knees squatting and helping his wife with the footwear

A lady with a Diabetic foot

Footwear designed and made at the RHC

The Husband helping her with the new footwear

Completed Footwear in place

The cobbler at work

Two Sides of a Coin

Couldn't resist posting these photos. Small children and an elderly gentleman. Both patients at the RHC. 

Children carrying a water can probably as heavy as the younger one. What struck me was the ease with which the older girl was carrying the can. How does she do it - watching her mother, or has she been trained?

The dignity of the old man waiting for his medications struck me. At the end of the day - patiently waiting his turn using the tree as a support.

Diabetic foot treatment at RHC

A Diabetic foot with ulcers

Orthotic footwear made at RHC

3 months later - voila healed

Oct to December 2017

The good rains continued through September and October. its such a lovely sight to see the fields green and lush.
Rishi Valley celebrated its 86th year with an alumni meet in November. It was a great time to reconnect with old friends and also get to know the younger generations of RVites.

The RHC kept us busy as usual.
 5275 patients over the 3 month period
460 children (M:F 225:235) and 1082 elderly (M:F 535:547)

A young baby who was operated for Cranial Synostosis in 2016 at St Johns Medical College, passed away due to complications and a general failure to thrive. The parents were heart broken, even though the child had severe brain damage and never completed his milestones.

July to September 2017

Wow Bountiful rains through September, the tanks have started filling up and the valley is green and lush. What hope in the air for all the farmers, daily wage workers, shepherds all those who make up our clientele
Busy as usual
 A Total of 7053 patients over the 3 month period
Children 248 M and 259 F
Elderly: 823 M and 850 F
Adults: 2012 M and 2861 F

Dr Kartik had been invited to give a guest lecture at his Alma Mater Institute of Aerospace Medicine, Bengaluru. It was a fun event giving back to the Institution.

April - June 2017

The hot months of summer brings a certain lassitude! We had quite a few patients with heat exhaustion, mainly the older people. A few young ones also. The waiting area though shaded is in the open, so heat load is high. Fans, earthen water pots (matkas) alleviate the heat to some extent.

As usual a large number of patients
4192 patients, 244 children and 750 elderly contributed to the load.

Everyone is waiting for the rains, fields lying fallow, the heat baking
The RHC closes for a summer break in May so all patients are covered till we get back.

Just a look at the NCD data over 01 years: Mind boggling

Hypertension: 6857

Diabetes: 9029

Hypothyroids: 469

Jan to March 2017

Wow its hot, March has been sizzling. Temperatures upwards of 38 Celsius and working in the heat in the mid afternoons - phew!!! Patients sit uncomplainingly

Lots of patients: 6968 of them, with the majority earning less than 48000 pa.
475 children below the ages of 15 and 981 elderly patients.

The drought has also affected the earning capacity. The effects of demonetisation are slowly fading though.

April promises to be hot as well

The year past saw us cover 22742 patients, an increase of 5% from the last year. Quality affordable outpatient medical care is so much needed. Almost 95% of illnesses could be treated at an outpatient level. The need is to have dedicated doctors and staff in rural areas. I frankly do not see it happening given the way our medical education is structured.

 This young girl had an extra orbital pseudo tumour which caused ptosis of the left eye. She was operated at Hyderabad and is slowly recovering.

 This old lady, with Hypertension, Stroke and Diabetes makes a trek of almost 40 km to reach the RHC. She has to change 3 buses to reach. We were able to help her with some transportation charges so is now able to hire an auto. She comes once in 4 months for a review.

 Young man with Congenital Hypothyroidism. Mis diagnosed and Mistreated - literally abandoned by his parents. Slowly brought under control. I suspect that he has other endocrine deficiencies too.
















Diabetic feet are so common - lack of foot care, injuries due to bare foot walking, poor nutrition all add up to this debilitating condition. Loss of earning capacity adds to the woes of the patients.

Throngs of patients. This was at 1700 having seen an OP of 180 patients

This young girl with type 1 Diabetes - is an aspiring state Basketball player. She made it up to the semifinals in the recently conducted nationals at Rajnandgaon. However she could not make the cut. Wondering whether her illness precluded her selection. 

She is well controlled on Insulin and has excellent parental support.

That's all for now folks. Looking forward to a break in May

Oct - Dec 2016

The final quarter of the year.
The first two week sof November saw the RHCtake a short break.
As usual the NE monsoon played out as a damp squib!. Cyclone Vardah deposied some 4 cm of rain and that's it
The month of December saw soms poor patient attendance primarily due to the cash crunch post demonetisation. However by the end o December things were looking up once again.

Total of 5366 patients
Children below 15: Males - 244 and Females - 174
Elderly (Above 65): Males - 338 and Females - 341
Adults: 1820 Males and 2449 females

Income Levels: 5101 earned less than INR 48000 pa and 265 were over 48000 pa

July - Sep 2016

The meteorological forecasts were optimistic - plenty of rains - unfortunately not a drop - the groundnuts have all withered, the jowar has gone - few straggly spike here and there. Makes one heart bleed
On the other side there was a sudden spurt in tomato prices - wow some families wiped out 10 years debt in one trip to the Tomato Market - suddenly there were new phones, new bikes visible on the country roads!!!!
Two sides of the same story
By end September all were wearing a glum look - withered crops, rapidly depleting ground water and soon the familiar sounds of a tractor pulling a trailer with water
Any way the RHC continued to be busy

Total of 6997 patients
Children below 15: Males 281 and Females 220
Elderly (above 65) Males 401 and females 385
Adults: 2657 Males and 3053 Females -
As is always the females tend to seek health more than males

Income levels less than 48000 pa 6683 and more than 48000 (APL) 314

Despair of Poverty - Cowering, hiding from the world and the wind

                                                                                                                                     This young boy swallowed a Re 1 coin - Bananas did the trick, The X Ray shows the coin in situ                                                                

Severe Osteo Arhritis - Helped with a knee brace

April - June 2016

Its been a hot summer, we had temperatures of more than 42 C for a month or so. In spite of exhortations, patients reported with heat exhaustion as well as heat hyperpyrexia. The elderly and the young were affected more than the able bodied
We also saw a few young males with Renal Stones - following the hot spell. Possibly dehydration due to farm work?
Patients continued in spite of the hot weather.
May provided a respite for all of us as it was a vacation time
Total Patients: 3522
<15 115="" 88="" p="">Children M: 115, F: 88
<15 115="" 88="" p="">Elderly M: 456,  F: 473
Adults M: 1172, F: 1218
<15 115="" 88="" p="">Income levels
<15 115="" 88="" p="">Below 48000: 3392
<15 115="" 88="" p="">Above 48000: 130

This little boy developed seizures, delayed milestones and also had an abnormally shaped head. He was diagnosed with Cranial Synostosis. Plastic surgery was done at St Johns Medical College. he is now recovering well and slowly improving

One of the most common afflictions of Diabetics - a diabetic foot. Poor hygiene, walking barefoot, poor diabetes control, smoking are all factors in causing this. Once affected the treatment is long affecting wage earning with its attendant problems of increasing poverty, depression etc. Apart from physical care most of these patients need psychological care to help them cope with this trauma.

Jan to March 2016

The financial year draws to a close. In spite of the heavy rains in October/November the heat has picked up. Working in the afternoons is quite difficult. Matakas of cool water are consumed to slake the thirst

Total Patients: 6323 

Below 15 years - Male: 280; Female: 258
Above 65 years - Male: 390; Female: 380
Adult: Male: 2546; Female: 2469

Income (₹) Distribution

Below 48000: 6167
Above 48001: 156

So we close the year with 21644 patients - first time that we have crossed 20000 patients in a fiscal,

April dawns!!!!

October - December 2015

Wow what a change - for the better - Splendid rains - rained continuously and we got a years rainfall in 2 weeks Approx 100 cm - gods be praised
Everyone has a big smile on their face and why not - the percolation tanks are full and overflowing, the streams running, borewells recharged - there is now drinking water in the bores as well as enough and more for agriculture. At least for the next year we should be comfortable
The big challenge is to get farmers to continue to conserve water and not waste it with indiscriminate flooding of the fields.

The Health centre also had a 2 week break over Deepavali. As usual it was terrific to put ones feet up and come back recharged

The number of patients took a dip because of the rains and increase in Agricultural activity

Total Patients: 4945 

Below 15 years - Male: 286; Female: 265
Above 65 years - Male: 213; Female: 208
Adult: Male: 2022; Female: 1951

Income (₹) Distribution

Below 12000: 3056
 12001 - 24000: 1422
 24001 - 36000: 249
36001 - 48000: 133
Above 48001: 85

July - September 2015

Decided to write up 3 monthly rather than monthly
The rains have played truant El Nino effect. Lots of dry weather bringing with it viral fevers, the flavour of the season being Dengue !!!
The Vascular Disease Project goes on and the data collection is in full swing. The response from the participants has been incredible.

As usual the data
Total Patients: 6769 

Below 15 years - Male: 365; Female: 382
Above 65 years - Male: 345; Female: 333
Adult: Male: 2610; Female: 2734

Income (₹) Distribution

Below 12000: 4096
 12001 - 24000: 2037
 24001 - 36000: 350
36001 - 48000: 171
Above 48001: 115

June 2015

Back after a months break, which was rather busy in itself. Early rains and the valley is looking green. However groundwater is fast depleting. Conflicting reports of the monsoon, skymet saying it  would be normal, while IMD predicting a deficiency. No planting has occurred while some farmers have ploughed their fields.
This slight increase in farming activity means that the number of patients also drops off. Also a large population has migrated out of the villages to cities looking for work.

Total Patients: 1515 

Below 15 years - Male: 94; Female: 97
Above 65 years - Male: 90; Female: 81
Adult: Male: 553; Female: 600

Income (₹) Distribution

Below 12000: 1059
 12001 - 24000: 316
 24001 - 36000: 74
36001 - 48000: 37
Above 48001: 29

April 2015

Its becoming increasingly hot. One has to drink water by the litre to keep hydrated and have some semblance of alertness while dealing with patients.
A couple of showers have helped cool the heat, albeit temporarily. Some relief!!!

Total Patients: 2092 

Below 15 years - Male: 87; Female: 82
Above 65 years - Male: 82; Female: 132
Adult: Male: 740; Female: 926

Income (₹) Distribution

Below 12000: 1231
 12001 - 24000: 618
 24001 - 36000: 127
36001 - 48000: 68
Above 48001: 48

Vignettes of Patients 2014 - 15

Severe Osteoarthritis of  both the knees making him unfit to do any kind of work.
Such patients are disadvantaged both economically as physically

Basal Cell Carcinoma of the cheek
No treatment available in Madanapalle and he is too old to travel

A 10 year old girl. Diagnosed as Hypothyroidism
Now on Eltroxin also investigating for other endocrine anomalies

o

Mental Retardation and Hemiplegia
Consanguinous parents

Microcephaly with early fusion of sutures
He also has hypospadias
Another victim of consanguinous marriages

A Diabetic with a large ulcer after debridement
With good control of sugars his foot is healing well

March 2015

Clear skies, warm nights and increasingly hot days. Summer is here and rather quickly. The trees are withered and all the leaves fallen off. Looks like a hot summer ahead. There is already talk of El Nino doing the rounds. Wonder what it augurs for our monsoon? 
The media has stopped reporting H1N1. Maybe the real issues will surface, but one doubts it as malnutrition, Diabetes, Hypertension are not headline grabbing stuff. 
The heat does not seem to affect the inflow of patients however. The crowds seem to have increased. Wonder where they get their money from with crop failures and no work?  

Total Patients: 2293 (Annual Total 2014 - 15: 19650, Annual Total 2013 - 14: 19477)

Below 15 years - Male: 125; Female: 120
Above 65 years - Male: 99; Female: 88
Adult: Male: 877; Female: 984

Income (₹) Distribution

Below 12000: 1364
 12001 - 24000: 737
 24001 - 36000: 108
36001 - 48000: 51
Above 48001: 33

February 2015

Clear skies, cool nights and mornings, a little bit of dew in the early hours, spring is here and a few new leaves. As yet nature has not indicated how the monsoon might be. 
A quite month, but for the H1N1 scare which seems quite misplaced, if one looks at the absolute numbers. More people die of TB, Malaria and other so called common illnesses and yet the media continues to write about this "new" disease!!!! Wonder how long the media interest will last. The response of the Min of Health has been graded and well thought out, No knee jerk reactions.

Total Patients: 1700

Below 15 years - Male: 97; Female: 89
Above 65 years - Male: 74; Female: 76
Adult: Male: 647; Female: 717

Income (₹) Distribution

Below 12000: 1032
 12001 - 24000: 538
 24001 - 36000: 63
36001 - 48000: 36
Above 48001: 31